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HomeMy WebLinkAboutInsurance Certificate: Robert Burstein , CERTIFICATE OF LIABILITY INSURANCE 0 UA2/13/2018 02/13/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teri Stephens Hart Insurance Agency PHONE FAX PO Box 1240 (541) 479-5521 A/C NO), (541) 474-1890 E-MAIL ADDRESS: hart®hartinsurance.com Grants PaBS OR 97528 INSURERS AFFORDING COVERAGE NAICB INSURER A: American Hallmark Insurance Co 43494 INSURED (541) 846-8914 INSURER B: Robert Burstein INSURER C P.O. Box 288 INSURER D: Williams OR 97544 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 6399 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSD ADDLISUBR POLICYNUMBER MMIDDY EFF MMIDDfYYYPY LIMITS WVQ LTR A rCOMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO CLAIMS-MADE % OCCUR 44CL443213 03/10/2018 03/10/2019 PREMISES E. ace ence $ 100,000 MED EXP(Anyone person $ 5,000 PERSONALS ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000,000 X POUCY D PJECTRO- ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accitlent ANYAUTO BODILY INJURY (Per person) $ DULED OWNED SCHEAUTOS AUTOS ONLY BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accitlent UMBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y STAME ER ANYPROPRIETOWPARTNERIEXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED7 (Mandatary In NH) E.L DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Public Works Department 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1